In this week of the Paris climate change summit, it is worth considering the health-care system’s contribution to climate change and how it can be reduced.
Health care, not surprisingly, is a bit of an energy pig. After all, the system is a large part of our economy — about 11 per cent of GDP — and with about two million workers, is the third-largest employment sector in Canada after retail and manufacturing.
Moreover, our hospitals run 24/7, use a lot of energy-intensive equipment and maintain an even temperature, no matter the outside temperature.
Whether the health-care system is a major source of greenhouse-gas emissions depends on their energy source. In provinces such as B.C., where most energy is hydroelectric, health facilities contribute to GHG emissions directly mainly through the use of oil or gas for space heating. But they contribute to GHG emissions in other ways, particularly through transportation and incineration of medical wastes.
Health care has large numbers of staff travelling to and from work, or as part of their work. As a high user of disposables — and thus a high generator of solid waste — health care also generates much truck traffic to move supplies and wastes. And millions of patients and their families travel to and from health-care facilities.
All of these activities mean that the health-care system, in its normal operations, is inadvertently doing harm to the environment, and thus to people. This is in direct contravention of one of the fundamental ethical precepts of health care: Primum non nocere — First, do no harm — which is embedded in the Hippocratic Oath.
In response to these challenges, the health-care sector has seen a dramatic growth in the movement toward environmentally responsible health care in the past 20 years.
At a global level, this is epitomized by Health Care Without Harm, a name inspired by the principle of doing no harm. It began in the U.S. in 1996 and today is an international coalition of more than 500 organizations in 53 countries.
In Canada, the Canadian Coalition for Green Health Care — which I co-founded — began in 2000, and is a well-established network, with many health-care facilities and organizations across the country, as well as business and NGO partners who are working to create more environmentally friendly goods and services. Energy efficiency is an important focus of their work.
In fact, the health-care system has done a reasonable job over the past 20 years or so in improving energy efficiency — and reaping the economic as well as the environmental benefits.
The Interior Health Authority has been a leader in B.C. Among its many actions, it has implemented a policy to ensure new facilities meet LEED Gold standards and has undertaken other energy-conservation measures, such as implementing more energy efficient lighting and adding solar power to some of its buildings. It has implemented a policy to make all new-vehicle purchases hybrid. In 2011, it won the Energy and Environmental Stewardship Award from the Canadian College of Health Leaders.
Another way of reducing GHG emissions is through telehealth, a technology widely used in B.C. that allows physicians to consult with patients and their local care providers remotely. Island Health reported its patients “have saved more than 3.7 million kilometres of travel to appointments.” An Interior Health study estimated just one of its telehealth programs saved 8.4 million patient-kilometres and hundreds of thousands of kilometres of consultant travel over two years, while reducing GHG emissions by more than 2,000 tonnes.
This is a large saving in patient travel costs and a reduction in GHGs and other air pollutants. But it also reduces the potential for road injuries for patients, families and staff, especially as some of that travel would be in winter road conditions. Clearly, by removing the need to travel we can reduce emissions, increase safety and improve access.
So health-care systems can reduce harm to the planet and to their patients and staff, while saving money. A pretty good return on investment!
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.